Acute bacterial prostatitis
- Alain Meyrier, MD
Alain Meyrier, MD
- Professor of Medicine (Emeritus)
- Université Paris-Descartes, Paris, France
- Thomas Fekete, MD
Thomas Fekete, MD
- Professor of Medicine and Microbiology
- Temple University School of Medicine
The prostate is subject to various inflammatory disorders . One of these syndromes is acute bacterial prostatitis, an acute infection of the prostate, usually caused by gram-negative organisms . The clinical presentation is generally well defined, and antimicrobial therapy remains the mainstay of treatment .
Acute bacterial prostatitis will be reviewed here. Chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome are discussed in detail elsewhere. (See "Chronic bacterial prostatitis" and "Chronic prostatitis/chronic pelvic pain syndrome".)
Other causes of dysuria in men, including cystitis, urethritis, and epididymitis, are also discussed elsewhere. (See "Acute uncomplicated cystitis and pyelonephritis in men" and "Urethritis in adult men" and "Evaluation of acute scrotal pain in adults", section on 'Acute epididymitis or epididymo-orchitis'.)
Entry of microorganisms into the prostate gland almost always occurs via the urethra. In most cases, bacteria migrate from the urethra or bladder through the prostatic ducts, with intraprostatic reflux of urine (figure 1). As a result, there may be concomitant infection in the bladder or epididymis. Uropathogenic bacterial isolates that cause prostatitis may have a higher accumulation of specialized virulence factors than those involved in cystitis alone [4,5].
Acute prostatitis can also occur from direct inoculation after transrectal prostate biopsy and transurethral manipulations (eg, catheterization and cystoscopy) [6,7]. (See "Prostate biopsy", section on 'Infection'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Pontari MA, Joyce GF, Wise M, et al. Prostatitis. J Urol 2007; 177:2050.
- Gill BC, Shoskes DA. Bacterial prostatitis. Curr Opin Infect Dis 2016; 29:86.
- Coker TJ, Dierfeldt DM. Acute Bacterial Prostatitis: Diagnosis and Management. Am Fam Physician 2016; 93:114.
- Johnson JR, Kuskowski MA, Gajewski A, et al. Extended virulence genotypes and phylogenetic background of Escherichia coli isolates from patients with cystitis, pyelonephritis, or prostatitis. J Infect Dis 2005; 191:46.
- Krieger JN, Dobrindt U, Riley DE, Oswald E. Acute Escherichia coli prostatitis in previously health young men: bacterial virulence factors, antimicrobial resistance, and clinical outcomes. Urology 2011; 77:1420.
- Kim SH, Ha US, Yoon BI, et al. Microbiological and clinical characteristics in acute bacterial prostatitis according to lower urinary tract manipulation procedure. J Infect Chemother 2014; 20:38.
- Ramakrishnan K, Salinas RC. Prostatitis: acute and chronic. Prim Care 2010; 37:547.
- Krieger JN, Nyberg L Jr, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA 1999; 282:236.
- Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol 1998; 159:1224.
- Wyndaele JJ. Complications of intermittent catheterization: their prevention and treatment. Spinal Cord 2002; 40:536.
- Mosharafa AA, Torky MH, El Said WM, Meshref A. Rising incidence of acute prostatitis following prostate biopsy: fluoroquinolone resistance and exposure is a significant risk factor. Urology 2011; 78:511.
- Ozden E, Bostanci Y, Yakupoglu KY, et al. Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy. Urology 2009; 74:119.
- Kim JW, Oh MM, Bae JH, et al. Clinical and microbiological characteristics of spontaneous acute prostatitis and transrectal prostate biopsy-related acute prostatitis: Is transrectal prostate biopsy-related acute prostatitis a distinct acute prostatitis category? J Infect Chemother 2015; 21:434.
- Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol 2008; 179:1379.
- Breyer BN, Van den Eeden SK, Horberg MA, et al. HIV status is an independent risk factor for reporting lower urinary tract symptoms. J Urol 2011; 185:1710.
- Lee LK, Dinneen MD, Ahmad S. The urologist and the patient infected with human immunodeficiency virus or with acquired immunodeficiency syndrome. BJU Int 2001; 88:500.
- Cornia PB, Takahashi TA, Lipsky BA. The microbiology of bacteriuria in men: a 5-year study at a Veterans' Affairs hospital. Diagn Microbiol Infect Dis 2006; 56:25.
- Millán-Rodríguez F, Palou J, Bujons-Tur A, et al. Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract. World J Urol 2006; 24:45.
- Etienne M, Chavanet P, Sibert L, et al. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis. BMC Infect Dis 2008; 8:12.
- Etienne M, Pestel-Caron M, Chapuzet C, et al. Should blood cultures be performed for patients with acute prostatitis? J Clin Microbiol 2010; 48:1935.
- Nagy V, Kubej D. Acute bacterial prostatitis in humans: current microbiological spectrum, sensitivity to antibiotics and clinical findings. Urol Int 2012; 89:445.
- Lipsky BA, Byren I, Hoey CT. Treatment of bacterial prostatitis. Clin Infect Dis 2010; 50:1641.
- Heyse AM, Dierick J, Vanhouteghem H, et al. A case of imported melioidosis presenting as prostatitis. Infection 2003; 31:60.
- Morse LP, Moller CC, Harvey E, et al. Prostatic abscess due to Burkholderia pseudomallei: 81 cases from a 19-year prospective melioidosis study. J Urol 2009; 182:542.
- Humphrey PA. Fungal prostatitis caused by coccidioides. J Urol 2014; 191:215.
- Smith JW, Jones SR, Reed WP, et al. Recurrent urinary tract infections in men. Characteristics and response to therapy. Ann Intern Med 1979; 91:544.
- Gamé X, Vincendeau S, Palascak R, et al. Total and free serum prostate specific antigen levels during the first month of acute prostatitis. Eur Urol 2003; 43:702.
- Siroky MB, Moylan R, Austen G Jr, Olsson CA. Metastatic infection secondary to genitourinary tract sepsis. Am J Med 1976; 61:351.
- Weinberger M, Cytron S, Servadio C, et al. Prostatic abscess in the antibiotic era. Rev Infect Dis 1988; 10:239.
- Horcajada JP, Vilana R, Moreno-Martínez A, et al. Transrectal prostatic ultrasonography in acute bacterial prostatitis: findings and clinical implications. Scand J Infect Dis 2003; 35:114.
- Trauzzi SJ, Kay CJ, Kaufman DG, Lowe FC. Management of prostatic abscess in patients with human immunodeficiency syndrome. Urology 1994; 43:629.
- Ludwig M, Schroeder-Printzen I, Schiefer HG, Weidner W. Diagnosis and therapeutic management of 18 patients with prostatic abscess. Urology 1999; 53:340.
- Thornhill BA, Morehouse HT, Coleman P, Hoffman-Tretin JC. Prostatic abscess: CT and sonographic findings. AJR Am J Roentgenol 1987; 148:899.
- Chia JK, Longfield RN, Cook DH, Flax BL. Computed axial tomography in the early diagnosis of prostatic abscess. Am J Med 1986; 81:942.
- Brede CM, Shoskes DA. The etiology and management of acute prostatitis. Nat Rev Urol 2011; 8:207.
- Wagenlehner FM, Weidner W, Naber KG. Therapy for prostatitis, with emphasis on bacterial prostatitis. Expert Opin Pharmacother 2007; 8:1667.
- Arakawa S, Kamidono S. Assessment of the UTI criteria for bacterial prostatitis in Japan. Infection 1992; 20 Suppl 3:S232.
- Yoon BI, Han DS, Ha US, et al. Clinical courses following acute bacterial prostatitis. Prostate Int 2013; 1:89.
- Risk factors
- CLINICAL MANIFESTATIONS
- - Prostatic abscess
- Evaluation for complications
- Evaluation for anatomical abnormalities
- DIFFERENTIAL DIAGNOSIS
- Indications for hospitalization
- Antimicrobial therapy
- - Duration of therapy
- Nonantimicrobial therapy
- Monitoring during therapy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS